EP1683473B1 - Device for use in treatment of hemorrhoidal prolapse - Google Patents

Device for use in treatment of hemorrhoidal prolapse Download PDF

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Publication number
EP1683473B1
EP1683473B1 EP06000772A EP06000772A EP1683473B1 EP 1683473 B1 EP1683473 B1 EP 1683473B1 EP 06000772 A EP06000772 A EP 06000772A EP 06000772 A EP06000772 A EP 06000772A EP 1683473 B1 EP1683473 B1 EP 1683473B1
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European Patent Office
Prior art keywords
tube
opening
closure
closure part
ligature
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EP06000772A
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German (de)
French (fr)
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EP1683473A1 (en
Inventor
Mathias Dr. Scheyer
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AMI Agency for Medical Innovations GmbH
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AMI Agency for Medical Innovations GmbH
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
    • A61B1/31—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor for the rectum, e.g. proctoscopes, sigmoidoscopes, colonoscopes
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
    • A61B1/00163—Optical arrangements
    • A61B1/00174—Optical arrangements characterised by the viewing angles
    • A61B1/00177—Optical arrangements characterised by the viewing angles for 90 degrees side-viewing
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/12—Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord
    • A61B17/12009—Implements for ligaturing other than by clamps or clips, e.g. using a loop with a slip knot
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/36—Image-producing devices or illumination devices not otherwise provided for
    • A61B90/37—Surgical systems with images on a monitor during operation
    • A61B2090/378—Surgical systems with images on a monitor during operation using ultrasound
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/48—Other medical applications
    • A61B5/4887—Locating particular structures in or on the body
    • A61B5/489—Blood vessels
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B8/00—Diagnosis using ultrasonic, sonic or infrasonic waves
    • A61B8/12—Diagnosis using ultrasonic, sonic or infrasonic waves in body cavities or body tracts, e.g. by using catheters
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/30—Devices for illuminating a surgical field, the devices having an interrelation with other surgical devices or with a surgical procedure

Definitions

  • the invention relates to a device for use in the treatment of a hemorrhoidal prolapse by attaching a gathering suture comprising a tube having a distal end with which it can be inserted into a rectum of a patient ahead, and an open proximal end and a jacket wall surrounding an inner cavity which is provided with an elongated opening extending in the axial direction of the tube, and a closure device which closes the opening in a closed position and from which the opening is successively releasable from distal to proximal and which has a closure part within which the tube is arranged and which is formed by a part of a shell of a hollow cylinder and is rotatable about the longitudinal axis of the tube relative to the tube.
  • One known surgical procedure is to incise cuts in the area of the ano-rectal junction and to ligate the exposed hemorrhoid arteries and to further remove enlarged hemorrhoids (proliferating nodules). This operation is painful for the patient as it occurs in the pain sensitive area of the ano-rectal junction. It is also an operation with greater invasiveness and the associated disadvantages and risks.
  • a device having the features of the preamble of claim 1 is known from US 295 798 A known. This device is known. This device is used in particular as a speculum. Even a treatment of the intestinal wall is feasible with this device.
  • the object of the invention is to provide a device which can be used advantageously for the simple setting of a gathering seam of a hemorrhoid prolapse, the setting of the gathering seam being standardized at least to a certain extent. According to the invention, this is achieved by a device having the features of patent claim 1.
  • the tube of the device is introduced into the rectum, wherein preferably a stop is provided, which limits the depth of the insertion.
  • the tube is rotated around its longitudinal axis in such a way that its elongated opening extending in the direction of the longitudinal axis of the tube comes to lie in the region of the prolapse.
  • the opening is initially closed by the closure device.
  • a first distal portion of the opening is released, with the prolapse mucosa bulging into the opening.
  • a first stitch of the gather seam to be set is performed.
  • another portion of the opening is released by means of the closure device, which connects proximally to the previously released portion of the opening. It is now carried out in this proximal subsequent section further piercing. This process is repeated until the desired number of punctures have been made.
  • Each of the punctures can be visually monitored very well and the punctures can be introduced at desired distances from the anus. The risk of getting too close to the Linea Dentata or towards the anus beyond this is reduced. Also, the piercings are easy and quickly introduced. The further knotting the seam can be done in a known manner.
  • a lighting device for illuminating the surgical area is present.
  • the closure device has a closure part surrounding the tube on the outside, which is formed by a part of a jacket of a hollow cylinder and which is rotatable relative to the tube about the longitudinal axis of this hollow cylinder or of the tube. Depending on the rotational position of the closure part, a more or less large distal portion of the elongate opening in the shell wall of the tube is released or the opening is closed.
  • An ultrasound sensor is arranged on the tube and the tube is provided with a ligature opening.
  • the device can thus also be used to ligate intramural arteries.
  • a ligature is usually preceded by the setting of a gather seam.
  • the ligature opening can also be closed by the closure device and released.
  • the ligature opening may be formed as a separate opening in the tube or as a lateral extension of the axial opening.
  • distal and proximal with respect to the device according to the invention should be understood to refer to the side facing the operator, i. H. the distal end of the device is the insertion end of the tube and the proximal end is the opposite end of the device.
  • proximal and distal refer to the position relative to the mouth of the patient. The tube is thus inserted into the distal rectum.
  • any prolapse of the mucosa of the distal rectum or the "cavernosum recti” is referred to as hemorrhoid prolapse.
  • Such prolactating mucosa is also referred to in this document as “mucosal prolapse", “prolapsed nodule”, “proliferating nodule”, “prolapsed hemorrhoidal pad” or “prolapsing appendage”.
  • FIGS. 1 to 7 An embodiment of a device according to the invention is shown in FIGS. 1 to 7.
  • the tube 1 has a peripheral wall 5 surrounding the inner cavity 4 of the tube 1. This is formed in the form of a circular ring, or in the region in which the opening 12 described below is arranged, in the form of a peripheral portion of a circular ring and in the region in this case surrounds the longitudinal axis 6 of the tube. 1
  • the proximal end 3 of the tube 1 is open and, in this embodiment, the tube 1 is also designed to be open at its distal end 2.
  • the tube 1 is attached to a holder 7, which has a handle 8 (only partly shown in FIG. 2).
  • the holder 7 has an inner cavity, which continues the inner cavity 4 of the tube 1.
  • the device can be sterilized or designed as a disposable instrument.
  • the tube 1 has a (at least substantially) cylindrical portion 24 and in the region of its proximal end 3 has a circumferentially widening portion 25 (the cylindrical portion 24 may also continue within the portion 25).
  • the jacket wall 5 of the tube 1 has an elongated opening 12 which extends in the axial direction of the tube 1 and is open toward the distal end 2 of the tube 1.
  • the distal end of the opening 12 thus coincides with the distal end 2 of the tube 1.
  • the proximal end 13 of the opening 12 is located in a proximal region of the cylindrical portion 24.
  • This elongated opening 12 could also be referred to as a slot or slot.
  • the opening 12 preferably extends over most of the length of the tube. 1
  • measured length of the opening 12 is at least twice as large as their measured perpendicular thereto width.
  • the length of the opening 12 is in the range of 40 to 80 mm.
  • Their width is favorably in the range of 8 to 20 mm.
  • the width of the opening 12 may vary over its axial extent, preferably slightly decreasing in the proximal direction.
  • the protruding over the bracket 7 axial length of the tube 1 is preferably in the range of 60 to 100 mm.
  • the axial opening 12 has a lateral extension which forms a ligature opening 26.
  • This ligature opening 26 is likewise open towards the distal end 2 of the tube 1.
  • the axial opening 12 and / or the ligature opening 26 do not extend to the distal end 2 of the tube 1, ie are designed as window openings.
  • the opening 12 and the ligature opening 26 may also be separated from each other.
  • an ultrasonic sensor 27 is mounted on the jacket wall 5 of the tube 1, and is driven by a along the jacket wall 5 extending electrical line 28.
  • the ultrasonic sensor 27 is disposed proximal to the ligature opening 26.
  • the overall sleeve-shaped closure device 15 comprises a closure part 16, which is adjoined proximally by an expanding, sectionally annular section 18. Distally, the closure member 16 is followed by a distal annular portion 29 which forms the distal end 30 of the occluder, tapering slightly towards the distal end 30 of the occluder 15.
  • stop elements 31 are arranged, which cooperate with stops 32, 33 of the holder 7.
  • the closure member 16 is formed in the form of a part of the shell of a hollow cylinder.
  • the closure member 16 is formed in the form of a hollow cylinder with an opening 34 in its jacket.
  • An edge 17 of this opening 34 has a section 17a extending helically around the longitudinal axis of the closure part 16 and a section 17b extending distally thereafter.
  • the edge 23 of the opening 34 extends in the axial direction.
  • the portion 17 a of the edge 17 is connected proximally to the edge 23 via a curved edge 35 of the opening 34.
  • the portion 17b of the rim 17 and the edge 23 extend to the distal end of the closure part 16 and are connected to each other via the proximal edge 36 of the portion 29 of the closure device.
  • the opening 34 thus represents a window opening in the shell of the overall sleeve-shaped closure device 15 in the illustrated embodiment.
  • the circumferential extent of the closure part 16 (ie the shell of the hollow cylinder which forms the closure part 16) is at least as large as the circumferential extent of the opening 12 and this circumferential extension of the closure part over the axial region in which the axial opening 12 extends in the tube 1 16 increases toward the proximal end of the closure member 16.
  • the closure device 15 can be plugged onto the tube 1 from its distal end 2, whereby in the state of use of the device the closure part 16 surrounds the tube 1 externally over a more or less large part of its circumference.
  • the inner diameter of the closure part 16 hereby corresponds, in addition to a clearance for forming a sliding guide on the tube 1, to the outer diameter of the portion of the tube 1 surrounded by the closure part 16.
  • the clearance is favorably less than 1 mm, a value of less than 0.3 mm being preferred is.
  • the closure device 15 with the closure part 16 is rotatable relative to the tube 1 about its longitudinal axis or the longitudinal axis of the tube 1.
  • the extended portion 18 has a serrated edge proximally. Depending on the rotational position, the following positions are assumed:
  • the device advantageously has a lighting device (not shown in FIGS. 1 to 7).
  • a lighting device (not shown in FIGS. 1 to 7).
  • a lighting device for example, in the holder 7 a plurality of spaced apart in the circumferential direction of the tube 1 light-emitting diodes 21 are arranged, which radiate into the proximal end of the widened portion 25 of the tube 1 and the light is forwarded in the shell wall 5 of the tube 1 by total reflection.
  • Desired exit points for the light can z. B. be formed by roughening the inner surface of the jacket wall to illuminate the operating area in the region of the opening 12.
  • Other lighting devices are conceivable and possible, wherein the light can be performed, for example, by means of one or more optical fibers in the tube 1 to near the surgical site. It can also be provided an external light source, is introduced from the light through a light guide cable in the device.
  • FIGS. 1 to 7 not only a gathering seam can be performed, but the device can also be used for a prior ligature of hemorrhoidal arteries or intramural arteries.
  • the tube 1 is introduced into the rectum with the parts of the closure device 15 surrounding it on the outside, in a rotational position corresponding to the position of a mucosal prolapse to be treated.
  • the closure device is here in her Closed position.
  • the extended portion 18 of the closure device 15 forms in the embodiment shown a stop for limiting the insertion of the tube. 1
  • the ligature is performed in a conventional manner by detecting corresponding arteries by means of the ultrasonic sensor 27 (and a corresponding control and evaluation electronics) through the ligation opening 26 to reduce the blood supply to the "Cavernosum recti".
  • the axial opening 12 is gradually released from its distal end 14, with a continuous suture being applied by the surgeon.
  • a slender needle holder and a correspondingly curved needle is worked through the inner cavity 4 of the tube 1.
  • the continuous suture is applied gradually over a length of 4 to 6 cm, to the vicinity of the dentate line.
  • the device After knotting the continuous suture in the region of the distal end 14 of the axial opening 12, the device is removed from the rectum, the occluder 15 is brought to the closed position, and the device re-introduced to treat the next prolapsed mucosal prolapse in the same manner. This is repeated until all mucosal incidents have been treated over the circumference of the rectum.
  • a closed at the distal end training of the tube 1 and / or the closure device 15 is conceivable and possible, but less preferred.
  • a locking device acting between the holder 7 and the closure device 15 may be present.

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Description

Die Erfindung betrifft eine Einrichtung zur Verwendung bei der Behandlung eines Hämorrhoidenprolaps durch Anbringung einer Raffungsnaht umfassend einen Tubus, der ein distales Ende, mit dem er voraus in ein Rektum eines Patienten einführbar ist, und ein offenes proximalles Ende und eine einen inneren Hohlraum umgebende Mantelwand aufweist, die mit einer länglichen Öffnung versehen ist, die sich in achsialer Richtung des Tubus erstreckt, und eine Verschlusseinrichtung, welche in einer Schließstellung die Öffnung schließt und von der die Öffnung sukzessive von distal nach proximal freigebbar ist und die ein Verschlussteil aufweist, innerhalb von dem der Tubus angeordnet ist und das von einem Teil eines Mantels eines Hohlzylinders gebildet wird und um die Längsachse des Tubus gegenüber dem Tubus verdrehbar ist.The invention relates to a device for use in the treatment of a hemorrhoidal prolapse by attaching a gathering suture comprising a tube having a distal end with which it can be inserted into a rectum of a patient ahead, and an open proximal end and a jacket wall surrounding an inner cavity which is provided with an elongated opening extending in the axial direction of the tube, and a closure device which closes the opening in a closed position and from which the opening is successively releasable from distal to proximal and which has a closure part within which the tube is arranged and which is formed by a part of a shell of a hollow cylinder and is rotatable about the longitudinal axis of the tube relative to the tube.

Ein bekanntes Operationsverfahren besteht darin, im Bereich des ano-rektalen Übergangs Schnitte einzubringen und die freigelegten Hämorrhoiden-Arterien abzubinden und weiters vergrößerte Hämorrhoiden (prolabierende Noduli) zu entfernen. Diese Operation ist für den Patienten schmerzhaft, da sie im schmerzempfindlichen Bereich des ano-rektalen Übergangs stattfindet. Außerdem handelt es sich um eine Operation mit einer größeren Invasivität und den damit verbundenen Nachteilen und Risken.One known surgical procedure is to incise cuts in the area of the ano-rectal junction and to ligate the exposed hemorrhoid arteries and to further remove enlarged hemorrhoids (proliferating nodules). This operation is painful for the patient as it occurs in the pain sensitive area of the ano-rectal junction. It is also an operation with greater invasiveness and the associated disadvantages and risks.

Bekannt ist weiters die Durchführung einer minimal-invasiven Hämorrhoiden-Arterienligatur mittels einer in das Rektum einzuführenden Ultraschallsonde. Im distalen Bereich eines Tubus ist ein Ultraschallsensor angeordnet, und zwar neben einer Öffnung in der Mantelwand des Tubus. Mittels des Ultraschallsensors wird eine innerhalb der Darmwand verlaufende Hämorrhoiden-Arterie lokalisiert, wobei in der Folge eine Ligatur der Arterie durch die Öffnung im Tubus erfolgt. Ein Vorteil dieser heute häufig angewendeten Behandlungsmethode ist neben der minimalen Invasivität, dass die Behandlung im Bereich der Darmwand oberhalb der Linea Dentata erfolgt und somit nicht in einem schmerzempfindlichen Bereich. Allerdings kann diese Methode bei einem Hämorrhoidenprolaps des III und IV Grades häufig nicht mehr den gewünschten Behandlungserfolg bringen. Es handelt sich hierbei um ausgeprägte prolabierende Hämorrhoidalpolster (= prolabierende Noduli) bzw. prolabierende Mukosa, die mehr oder weniger ausgeprägt und mehr oder weniger permanent aus dem Anus prolabieren. Derartige Einrichtungen zur Hämorrhoiden-Arterienligatur sind beispielsweise aus der US 5,570,692 A und der EP 1 234 539 A2 bekannt.It is also known to carry out a minimally invasive hemorrhoid arterial ligation by means of an ultrasound probe to be introduced into the rectum. In the distal region of a tube, an ultrasonic sensor is arranged, next to an opening in the shell wall of the tube. By means of the ultrasonic sensor, a hemorrhoidal artery running within the intestinal wall is localized, as a result of which the artery is ligated through the opening in the tube. An advantage of this treatment method, which is commonly used today, apart from the minimal invasiveness, is that the treatment takes place in the area of the intestinal wall above the linea dentata and thus not in a pain-sensitive area. However, this method can often no longer bring the desired treatment success in a hemorrhoid prolapse of the III and IV degree. These are pronounced prolapsed Hämorrhoidalpolster (= prolapsing nodules) or prolapsed mucosa, which more or less pronounced and more or less permanently prolapse from the anus. Such devices for hemorrhoids Arterienligatur are for example from the US 5,570,692 A and the EP 1 234 539 A2 known.

Es wurden weiters vereinzelt bereits Operationen durchgeführt, bei welchen die prolabierenden Noduli mittels Raffungsnähten gerafft wurden, um den Prolaps wesentlich zu verringern. Diese Operationen haben sich jedoch als technisch schwierig erwiesen, da je nach Befund der Prolaps der Schleimhaut zielgerechte Durchstechungen in diesem Bereich verunmöglicht, die Einhaltung eines ausreichenden Abstands zur Linea Dentata nicht ausreichend kontrollierbar ist (Schmerzen sind die Folge) und der Zeitaufwand für die Einzeldurchstechungen zu groß ist (vier bis fünf Durchstechungen sind meist erforderlich, um zum gewünschten Erfolg zu gelangen). Diese Operationsmethode hat sich daher nicht durchgesetzt und gehört zu keiner der heute angewendeten Standardoperationsmethoden.Sporadic operations have been carried out in which the proliferating nodules have been ruffled by means of gathering sutures in order to substantially reduce the prolapse. However, these operations have proved to be technically difficult, since depending on the findings of the prolapse of the mucous membrane targeted Durchstechungen made impossible in this area, compliance with a sufficient distance to the Linea Dentata is not sufficiently controlled (pain is the result) and the time required for the individual Durchstechungen is large (four to five piercings are usually required to get the desired result). This method of operation has therefore not prevailed and does not belong to any of the standard operating methods used today.

Eine Einrichtung mit den Merkmalen des Oberbegriffs des Patentanspruchs 1 ist aus der US 295 798 A bekannt. Diese Einrichtung bekannt. Diese Einrichtung dient insbesondere als Spekulum. Auch eine Behandlung der Darmwand ist mit dieser Einrichtung durchführbar.A device having the features of the preamble of claim 1 is known from US 295 798 A known. This device is known. This device is used in particular as a speculum. Even a treatment of the intestinal wall is feasible with this device.

Aufgabe der Erfindung ist es, eine Einrichtung bereitzustellen, die in vorteilhafter Weise zum einfachen Setzen einer Raffungsnaht eines Hämorrhoiden-Prolaps einsetzbar ist, wobei das Setzen der Raffungsnaht zumindest bis zu einem gewissen Grad, standardisiert wird. Erfindungsgemäß gelingt dies durch eine Einrichtung mit den Merkmalen des Patentanspruchs 1.The object of the invention is to provide a device which can be used advantageously for the simple setting of a gathering seam of a hemorrhoid prolapse, the setting of the gathering seam being standardized at least to a certain extent. According to the invention, this is achieved by a device having the features of patent claim 1.

Zum Setzen einer Raffungsnaht wird der Tubus der Einrichtung in das Rektum eingeführt, wobei vorzugsweise ein Anschlag vorgesehen ist, der die Tiefe des Einführens begrenzt. Der Tubus wird hierbei derart um seine Längsachse gedreht, dass seine in Richtung der Längsachse des Tubus sich erstreckende längliche Öffnung im Bereich des Prolaps zu liegen kommt. Die Öffnung ist zunächst durch die Verschlusseinrichtung verschlossen.To set a gather seam, the tube of the device is introduced into the rectum, wherein preferably a stop is provided, which limits the depth of the insertion. In this case, the tube is rotated around its longitudinal axis in such a way that its elongated opening extending in the direction of the longitudinal axis of the tube comes to lie in the region of the prolapse. The opening is initially closed by the closure device.

Um die Naht auszuführen, wird ein erster distaler Abschnitt der Öffnung freigegeben, wobei die Schleimhaut des Prolaps sich in die Öffnung hineinwölbt. In diesem Bereich wird ein erster Stich der zu setzenden Raffungsnaht durchgeführt. In der Folge wird ein weiterer Abschnitt der Öffnung mittels der Verschlusseinrichtung freigegeben, der proximal an den zuvor freigegebenen Abschnitt der Öffnung anschließt. Es wird nunmehr in diesem proximal anschließenden Abschnitt eine weitere Durchstechung durchgeführt. Dieser Vorgang wird wiederholt, bis die gewünschte Anzahl von Durchstechungen durchgeführt worden ist. Jede der Durchstechungen kann sehr gut optisch überwacht werden und die Durchstechungen können in gewünschten Abständen vom Anus eingebracht werden. Die Gefahr, zu nahe zur Linea Dentata oder in Richtung zum Anus über diese hinaus zu gelangen, wird hierbei verringert. Auch sind die Durchstechungen einfach und rasch einbringbar. Das weitere Knüpfen der Naht kann in bekannter Weise erfolgen.To perform the suture, a first distal portion of the opening is released, with the prolapse mucosa bulging into the opening. In this area, a first stitch of the gather seam to be set is performed. As a result, another portion of the opening is released by means of the closure device, which connects proximally to the previously released portion of the opening. It is now carried out in this proximal subsequent section further piercing. This process is repeated until the desired number of punctures have been made. Each of the punctures can be visually monitored very well and the punctures can be introduced at desired distances from the anus. The risk of getting too close to the Linea Dentata or towards the anus beyond this is reduced. Also, the piercings are easy and quickly introduced. The further knotting the seam can be done in a known manner.

Vorteilhafterweise ist eine Beleuchtungseinrichtung zur Beleuchtung des Operationsbereiches vorhanden.Advantageously, a lighting device for illuminating the surgical area is present.

Die Verschlusseinrichtung weist erfindungsgemäß ein den Tubus außen umgebendes Verschlussteil auf, das von einem Teil eines Mantels eines Hohlzylinders gebildet wird und das um die Längsachse dieses Hohlzylinders bzw. des Tubus gegenüber dem Tubus verdrehbar ist. Je nach Drehstellung des Verschlussteils wird ein mehr oder weniger großer distaler Abschnitt der länglichen Öffnung in der Mantelwand des Tubus freigegeben oder die Öffnung wird verschlossen.According to the invention, the closure device has a closure part surrounding the tube on the outside, which is formed by a part of a jacket of a hollow cylinder and which is rotatable relative to the tube about the longitudinal axis of this hollow cylinder or of the tube. Depending on the rotational position of the closure part, a more or less large distal portion of the elongate opening in the shell wall of the tube is released or the opening is closed.

Am Tubus ist ein Ultraschallsensor angeordnet und der Tubus ist mit einer Ligaturöffnung versehen. Die Einrichtung kann somit auch dazu eingesetzt werden, um intramurale Arterien zu ligieren. Eine solche Ligatur geht dem Setzen einer Raffungsnaht üblicherweise voraus. Vorteilhafterweise ist die Ligaturöffnung ebenfalls von der Verschlusseinrichtung verschließbar und freigebbar. Die Ligaturöffnung kann als separate Öffnung im Tubus oder als seitliche Erweiterung der achsialen Öffnung ausgebildet sein.An ultrasound sensor is arranged on the tube and the tube is provided with a ligature opening. The device can thus also be used to ligate intramural arteries. Such a ligature is usually preceded by the setting of a gather seam. Advantageously, the ligature opening can also be closed by the closure device and released. The ligature opening may be formed as a separate opening in the tube or as a lateral extension of the axial opening.

Die Begriffe distal und proximal in Bezug auf die erfindungsgemäße Einrichtung sind so zu verstehen, dass diese auf die Seite bezogen sind, die dem Operateur zugewandt ist, d. h. das distale Ende der Einrichtung ist das Einführende des Tubus und das proximale Ende ist das gegenüberliegende Ende der Einrichtung. Auf den Gastro-Intestinal-Trakt bezogen bezeichnen die Begriffe proximal und distal dagegen die Lage relativ zum Mund des Patienten. Der Tubus wird somit in das distale Rektum eingeführt.The terms distal and proximal with respect to the device according to the invention should be understood to refer to the side facing the operator, i. H. the distal end of the device is the insertion end of the tube and the proximal end is the opposite end of the device. With regard to the gastrointestinal tract, however, the terms proximal and distal refer to the position relative to the mouth of the patient. The tube is thus inserted into the distal rectum.

Als Hämorrhoidenprolaps wird im Rahmen dieser Schrift jeder Prolaps der Schleimhaut des distalen Rektums bzw. des "Cavernosum recti" bezeichnet. Solche prolabierende Schleimhaut wird in dieser Schrift auch als "Mukosaprolaps", "prolabierender Knoten", "prolabierender Nodulus", "prolabierendes Hämorrhoidalpolster" oder "prolabierender Fortsatz" bezeichnet.In the context of this document, any prolapse of the mucosa of the distal rectum or the "cavernosum recti" is referred to as hemorrhoid prolapse. Such prolactating mucosa is also referred to in this document as "mucosal prolapse", "prolapsed nodule", "proliferating nodule", "prolapsed hemorrhoidal pad" or "prolapsing appendage".

Weitere Vorteile und Einzelheiten der Erfindung werden im Folgenden anhand der beiliegenden Zeichnung erläutert. In dieser zeigen:

Fig. 1 und Fig. 2
Schrägsichten von schräg hinten und schräg vorne einer Ausführungsform der Erfindung, in der Ligaturstellung der Verschlusseinrichtung (Fig. 1 zeigt die Einrichtung ohne den Handgriff und in Fig. 2 ist nur ein Abschnitt des Handgriffs dargestellt);
Fig. 3
und Fig. 4 Schrägsichten aus verschiedenen Blickrichtungen im auseinandergezogenen Zustand des Tubus und der Verschlusseinrichtung;
Fig. 5
die Einrichtung in der Schließstellung;
Fig. 6
eine Zwischenstellung und
Fig. 7
die Einrichtung in der Offenstellung der Verschlusseinrichtung, in der die achsiale Öffnung im Tubus vollständig freigegeben ist.
Further advantages and details of the invention are explained below with reference to the accompanying drawings. In this show:
Fig. 1 and Fig. 2
Oblique views obliquely from behind and obliquely at the front of an embodiment of the invention, in the ligature position of the closure device (Figure 1 shows the device without the handle and in Fig. 2, only a portion of the handle is shown).
Fig. 3
and FIG. 4 shows oblique views from different viewing directions in the extended state of the tube and the closure device; FIG.
Fig. 5
the device in the closed position;
Fig. 6
an intermediate position and
Fig. 7
the device in the open position of the closure device, in which the axial opening in the tube is completely released.

Ein Ausführungsbeispiel einer erfindungsgemäßen Einrichtung ist in den Fig. 1 bis 7 dargestellt. Die Einrichtung umfasst einen Tubus 1 (= eine Hülse) und eine weiter unten genauer erläuterte, um die Längsachse 6 des Tubus 1 drehbar angeordnete Verschlusseinrichtung 15.An embodiment of a device according to the invention is shown in FIGS. 1 to 7. The device comprises a tube 1 (= a sleeve) and a closure device 15, which is explained in more detail below and is rotatable about the longitudinal axis 6 of the tube 1.

Der Tubus 1 besitzt eine den inneren Hohlraum 4 des Tubus 1 umgebende Mantelwand 5. Diese ist im Querschnitt gesehen in Form eines Kreisrings, bzw. im Bereich, in welchem die weiter unten beschriebene Öffnung 12 angeordnet ist, in Form eines Umfangsabschnitts eines Kreisrings ausgebildet und umgibt hierbei die Längsachse 6 des Tubus 1.The tube 1 has a peripheral wall 5 surrounding the inner cavity 4 of the tube 1. This is formed in the form of a circular ring, or in the region in which the opening 12 described below is arranged, in the form of a peripheral portion of a circular ring and in the region in this case surrounds the longitudinal axis 6 of the tube. 1

Das proximale Ende 3 des Tubus 1 ist offen ausgebildet und in diesem Ausführungsbeispiel ist der Tubus 1 auch an seinem distalen Ende 2 offen ausgebildet. Der Tubus 1 ist an einer Halterung 7 angebracht, die einen Handgriff 8 aufweist (nur in Fig. 2 teilweise dargestellt). Die Halterung 7 besitzt einen inneren Hohlraum, der den inneren Hohlraum 4 des Tubus 1 fortsetzt.The proximal end 3 of the tube 1 is open and, in this embodiment, the tube 1 is also designed to be open at its distal end 2. The tube 1 is attached to a holder 7, which has a handle 8 (only partly shown in FIG. 2). The holder 7 has an inner cavity, which continues the inner cavity 4 of the tube 1.

Unterschiedliche Befestigungen des Tubus 1 an der Halterung 7 sind denkbar und möglich. Ebenso sind einstückige Ausbildungen des Tubus 1 mit der Halterung 7 denkbar und möglich. Die Einrichtung kann sterilisierbar oder als Einmalinstrument ausgebildet sein.Different attachments of the tube 1 to the holder 7 are conceivable and possible. Likewise, one-piece designs of the tube 1 with the holder 7 are conceivable and possible. The device can be sterilized or designed as a disposable instrument.

Der Tubus 1 besitzt einen (zumindest im Wesentlichen) zylindrischen Abschnitt 24 und im Bereich seines proximalen Endes 3 einen sich in seinem Umfang erweiternden Abschnitt 25 (der zylindrische Abschnitt 24 kann sich auch innerhalb des Abschnitts 25 fortsetzen).The tube 1 has a (at least substantially) cylindrical portion 24 and in the region of its proximal end 3 has a circumferentially widening portion 25 (the cylindrical portion 24 may also continue within the portion 25).

Die Mantelwand 5 des Tubus 1 besitzt eine in achsialer Richtung des Tubus 1 sich erstreckende längliche Öffnung 12, die zum distalen Ende 2 des Tubus 1 hin offen ist. Das distale Ende der Öffnung 12 fällt also mit dem distalen Ende 2 des Tubus 1 zusammen. Das proximale Ende 13 der Öffnung 12 befindet sich in einem proximalen Bereich des zylindrischen Abschnitts 24.The jacket wall 5 of the tube 1 has an elongated opening 12 which extends in the axial direction of the tube 1 and is open toward the distal end 2 of the tube 1. The distal end of the opening 12 thus coincides with the distal end 2 of the tube 1. The proximal end 13 of the opening 12 is located in a proximal region of the cylindrical portion 24.

Diese längliche Öffnung 12 könnte auch als Langloch oder Schlitz bezeichnet werden. Die Öffnung 12 verläuft vorzugsweise über den Großteil der Länge des Tubus 1.This elongated opening 12 could also be referred to as a slot or slot. The opening 12 preferably extends over most of the length of the tube. 1

Vorzugsweise ist in achsialer Richtung des Tubus 1 gemessene Länge der Öffnung 12 mindestens doppelt so groß wie ihre senkrecht hierzu gemessene Breite. Günstigerweise liegt die Länge der Öffnung 12 im Bereich von 40 bis 80 mm. Ihre Breite liegt günstigerweise im Bereich von 8 bis 20 mm.Preferably, in the axial direction of the tube 1 measured length of the opening 12 is at least twice as large as their measured perpendicular thereto width. Conveniently, the length of the opening 12 is in the range of 40 to 80 mm. Their width is favorably in the range of 8 to 20 mm.

Die Breite der Öffnung 12 kann sich über ihre achsiale Ausdehnung ändern, vorzugsweise in proximaler Richtung etwas verringern.The width of the opening 12 may vary over its axial extent, preferably slightly decreasing in the proximal direction.

Die über die Halterung 7 vorstehende achsiale Länge des Tubus 1 liegt vorzugsweise im Bereich von 60 bis 100 mm.The protruding over the bracket 7 axial length of the tube 1 is preferably in the range of 60 to 100 mm.

In einem an das distale Ende 2 des Tubus 1 anschließenden Bereich besitzt die achsiale Öffnung 12 eine seitliche Erweiterung, die eine Ligaturöffnung 26 bildet. Diese Ligaturöffnung 26 ist ebenfalls zum distalen Ende 2 des Tubus 1 hin offen.In an area adjoining the distal end 2 of the tube 1, the axial opening 12 has a lateral extension which forms a ligature opening 26. This ligature opening 26 is likewise open towards the distal end 2 of the tube 1.

Denkbar und möglich wäre es auch, dass die achsiale Öffnung 12 und/oder die Ligaturöffnung 26 nicht bis zum distalen Ende 2 des Tubus 1 verlaufen, also als Fensteröffnungen ausgebildet sind. Die Öffnung 12 und die Ligaturöffnung 26 können auch voneinander separiert sein.It would also be conceivable and possible that the axial opening 12 and / or the ligature opening 26 do not extend to the distal end 2 of the tube 1, ie are designed as window openings. The opening 12 and the ligature opening 26 may also be separated from each other.

An der Mantelwand 5 des Tubus 1 ist ein Ultraschallsensor 27 angebracht und wird über eine entlang der Mantelwand 5 verlaufende elektrische Leitung 28 angesteuert. Der Ultraschallsensor 27 ist proximal neben der Ligaturöffnung 26 angeordnet.On the jacket wall 5 of the tube 1, an ultrasonic sensor 27 is mounted and is driven by a along the jacket wall 5 extending electrical line 28. The ultrasonic sensor 27 is disposed proximal to the ligature opening 26.

Die insgesamt hülsenförmig ausgebildete Verschlusseinrichtung 15 umfasst ein Verschlussteil 16, an welches proximal ein sich erweiternder, im Querschnitt ringförmiger Abschnitt 18 anschließt. Distal schließt an das Verschlussteil 16 ein distaler ringförmiger Abschnitt 29 an, der das distale Ende 30 der Verschlusseinrichtung bildet, wobei er sich zum distalen Ende 30 der Verschlusseinrichtung 15 hin etwas verjüngt.The overall sleeve-shaped closure device 15 comprises a closure part 16, which is adjoined proximally by an expanding, sectionally annular section 18. Distally, the closure member 16 is followed by a distal annular portion 29 which forms the distal end 30 of the occluder, tapering slightly towards the distal end 30 of the occluder 15.

Am Abschnitt 18 der Verschlusseinrichtung 15 sind Anschlagelemente 31 angeordnet, die mit Anschlägen 32, 33 der Halterung 7 zusammenwirken.At the portion 18 of the closure device 15 stop elements 31 are arranged, which cooperate with stops 32, 33 of the holder 7.

Das Verschlussteil 16 ist in Form eines Teils des Mantels eines Hohlzylinders ausgebildet. Anders ausgedrückt ist das Verschlussteil 16 in Form eines Hohlzylinders mit einer Öffnung 34 in seinem Mantel ausgebildet. Ein Rand 17 dieser Öffnung 34 weist einen schraubenartig um die Längsachse des Verschlussteils 16 verlaufenden Abschnitt 17a und einen distal daran anschließenden achsial verlaufenden Abschnitt 17b auf. Der Rand 23 der Öffnung 34 verläuft in achsialer Richtung. Der Abschnitt 17a des Randes 17 ist proximal mit dem Rand 23 über einen gebogenen Rand 35 der Öffnung 34 verbunden. Der Abschnitt 17b des Randes 17 und der Rand 23 verlaufen bis zum distalen Ende des Verschlussteils 16 und sind dort über den proximalen Rand 36 des Abschnitts 29 der Verschlusseinrichtung miteinander verbunden.The closure member 16 is formed in the form of a part of the shell of a hollow cylinder. In other words, the closure member 16 is formed in the form of a hollow cylinder with an opening 34 in its jacket. An edge 17 of this opening 34 has a section 17a extending helically around the longitudinal axis of the closure part 16 and a section 17b extending distally thereafter. The edge 23 of the opening 34 extends in the axial direction. The portion 17 a of the edge 17 is connected proximally to the edge 23 via a curved edge 35 of the opening 34. The portion 17b of the rim 17 and the edge 23 extend to the distal end of the closure part 16 and are connected to each other via the proximal edge 36 of the portion 29 of the closure device.

Die Öffnung 34 stellt somit im gezeigten Ausführungsbeispiel eine Fensteröffnung im Mantel der insgesamt hülsenförmigen Verschlusseinrichtung 15 dar.The opening 34 thus represents a window opening in the shell of the overall sleeve-shaped closure device 15 in the illustrated embodiment.

Die Umfangserstreckung des Verschlussteils 16 (also des Mantels des Hohlzylinders, der das Verschlussteil 16 bildet) ist über den achsialen Bereich, in dem sich die achsiale Öffnung 12 im Tubus 1 erstreckt, zumindest so groß wie die Umfangserstreckung der Öffnung 12 und diese Umfangserstreckung des Verschlussteils 16 nimmt zum proximalen Ende des Verschlussteils 16 hin zu.The circumferential extent of the closure part 16 (ie the shell of the hollow cylinder which forms the closure part 16) is at least as large as the circumferential extent of the opening 12 and this circumferential extension of the closure part over the axial region in which the axial opening 12 extends in the tube 1 16 increases toward the proximal end of the closure member 16.

Die Verschlusseinrichtung 15 ist in diesem Ausführungsbeispiel auf den Tubus 1 von seinem distalen Ende 2 her aufsteckbar, wobei im Benutzungszustand der Einrichtung das Verschlussteil 16 den Tubus 1 außen über einen mehr oder weniger großen Teil seines Umfangs umgibt. Der Innendurchmesser des Verschlussteils 16 entspricht hierbei zuzüglich eines Spiels zur Ausbildung einer Gleitführung auf dem Tubus 1 dem Außendurchmesser des vom Verschlussteil 16 umgebenen Abschnitts des Tubus 1. Das Spiel beträgt günstigerweise weniger als 1 mm, wobei ein Wert von weniger als 0,3 mm bevorzugt ist. Im Benutzungszustand der Einrichtung liegen der Tubus 1 und das Verschlussteil 16 koachsial zueinander.In this exemplary embodiment, the closure device 15 can be plugged onto the tube 1 from its distal end 2, whereby in the state of use of the device the closure part 16 surrounds the tube 1 externally over a more or less large part of its circumference. The inner diameter of the closure part 16 hereby corresponds, in addition to a clearance for forming a sliding guide on the tube 1, to the outer diameter of the portion of the tube 1 surrounded by the closure part 16. The clearance is favorably less than 1 mm, a value of less than 0.3 mm being preferred is. When the device is in use, the tube 1 and the closure part 16 are coaxial with each other.

Die Verschlusseinrichtung 15 mit dem Verschlussteil 16 ist gegenüber dem Tubus 1 um seine Längsachse bzw. die Längsachse des Tubus 1 verdrehbar. Zur Erleichterung der Verdrehung besitzt der erweiterte Abschnitt 18 proximal einen geriffelten Rand. Je nach Drehstellung werden hierbei die folgenden Stellungen eingenommen:The closure device 15 with the closure part 16 is rotatable relative to the tube 1 about its longitudinal axis or the longitudinal axis of the tube 1. To facilitate the twist the extended portion 18 has a serrated edge proximally. Depending on the rotational position, the following positions are assumed:

In der Drehstellung, in der ein Anschlagelement 31 der Verschlusseinrichtung 15 am Anschlag 33 der Halterung 7 anliegt, ist die achsiale Öffnung 12 im Tubus 1 vom Verschlussteil 16 verschlossen, aber die Ligaturöffnung 26 im Tubus 1 ist freigegeben. Diese Stellung wird als "Ligaturstellung" bezeichnet (vgl. Fig. 1 und 2).In the rotational position in which a stop element 31 of the closure device 15 bears against the stop 33 of the holder 7, the axial opening 12 in the tube 1 is closed by the closure part 16, but the ligature opening 26 in the tube 1 is released. This position is referred to as "ligature position" (see Figures 1 and 2).

Im vollständig in die andere Endstellung verdrehten Zustand der Verschlusseinrichtung 15, in welchem ein Anschlagelement 31 am Anschlag 32 der Halterung 7 anliegt, sind sowohl die achsiale Öffnung 12 als auch die Ligaturöffnung 26 des Tubus 1 vom Verschlussteil 16 abgedeckt und diese Stellung wird als "Schließstellung" bezeichnet. Diese Stellung ist in Fig. 5 dargestellt. In Fig. 5 ist der Abschnitt 18 der Verschlusseinrichtung hierbei geringfügig modifiziert dargestellt, insbesondere sind die beiden Anschlagelemente 31 als ein Stück ausgebildet und die Riffelung am Rand ist nicht dargestellt. Dies trifft auch auf Fig. 6 und Fig. 7 zu.In the fully rotated in the other end position state of the closure device 15, in which a stop member 31 abuts against the stop 32 of the holder 7, both the axial opening 12 and the ligature opening 26 of the tube 1 are covered by the closure member 16 and this position is called "closed position " designated. This position is shown in Fig. 5. In Fig. 5, the portion 18 of the closure device is hereby shown slightly modified, in particular, the two stop members 31 are formed as one piece and the corrugation at the edge is not shown. This also applies to FIG. 6 and FIG. 7.

Wenn die Verschlusseinrichtung 15 ausgehend von der Schließstellung in Richtung zur Ligaturstellung gedreht wird, so wird die achsiale Öffnung 12 des Tubus 1 zunehmend von distal nach proximal freigegeben, bis sie über ihre ganze Länge freigegeben ist und die "Offenstellung" erreicht ist (vgl. Fig. 7). Die Stellungen, in denen nur ein distaler Abschnitt der achsialen Öffnung 12 des Tubus 1 freigegeben ist, werden als "Zwischenstellungen" bezeichnet. Eine Zwischenstellung ist in Fig. 6 dargestellt.When the closure device 15 is rotated starting from the closed position in the direction of the ligature position, the axial opening 12 of the tube 1 is increasingly released from distal to proximal until it is released over its entire length and the "open position" is reached (cf. 7). The positions in which only a distal portion of the axial opening 12 of the tube 1 is released are referred to as "intermediate positions". An intermediate position is shown in Fig. 6.

Die Einrichtung weist vorteilhafterweise eine Beleuchtungseinrichtung auf (nicht dargestellt in den Fig. 1 bis 7). Beispielsweise sind in der Halterung 7 mehrere in Umfangsrichtung des Tubus 1 voneinander beabstandete Leuchtdioden 21 angeordnet, die in das proximale Ende des erweiterten Abschnitts 25 des Tubus 1 einstrahlen und deren Licht in der Mantelwand 5 des Tubus 1 durch Totalreflexion weitergeleitet wird. Gewünschte Austrittsstellen für das Licht können z. B. durch Aufrauungen der Innenfläche der Mantelwand ausgebildet werden, um den Operationsbereich im Bereich der Öffnung 12 zu beleuchten. Auch andere Beleuchtungseinrichtungen sind denkbar und möglich, wobei das Licht beispielsweise mittels eines oder mehrerer Lichtleiter im Tubus 1 bis in die Nähe der Operationsstelle geführt sein kann. Es kann auch eine externe Lichtquelle vorgesehen sein, von der Licht durch ein Lichtleitkabel in die Einrichtung eingeleitet wird.The device advantageously has a lighting device (not shown in FIGS. 1 to 7). For example, in the holder 7 a plurality of spaced apart in the circumferential direction of the tube 1 light-emitting diodes 21 are arranged, which radiate into the proximal end of the widened portion 25 of the tube 1 and the light is forwarded in the shell wall 5 of the tube 1 by total reflection. Desired exit points for the light can z. B. be formed by roughening the inner surface of the jacket wall to illuminate the operating area in the region of the opening 12. Other lighting devices are conceivable and possible, wherein the light can be performed, for example, by means of one or more optical fibers in the tube 1 to near the surgical site. It can also be provided an external light source, is introduced from the light through a light guide cable in the device.

Mit der in den Fig. 1 bis 7 dargestellten Einrichtung kann nicht nur eine Raffungsnaht durchgeführt werden, sondern die Einrichtung kann auch für eine vorausgehende Ligatur von Hämorrhoidalarterien bzw. intramuralen Arterien eingesetzt werden.With the device shown in FIGS. 1 to 7 not only a gathering seam can be performed, but the device can also be used for a prior ligature of hemorrhoidal arteries or intramural arteries.

Hierbei wird der Tubus 1 mit den diesen außen umgebenden Teilen der Verschlusseinrichtung 15 in das Rektum eingeführt, und zwar in einer Drehstellung entsprechend der Lage eines zu behandelnden Schleimhautvorfalls. Die Verschlusseinrichtung befindet sich hierbei in ihrer Schließstellung. Der erweiterte Abschnitt 18 der Verschlusseinrichtung 15 bildet im gezeigten Ausführungsbeispiel einen Anschlag zur Begrenzung des Einführens des Tubus 1.In this case, the tube 1 is introduced into the rectum with the parts of the closure device 15 surrounding it on the outside, in a rotational position corresponding to the position of a mucosal prolapse to be treated. The closure device is here in her Closed position. The extended portion 18 of the closure device 15 forms in the embodiment shown a stop for limiting the insertion of the tube. 1

Zur anschließenden Ligatur von intramuralen (=in der Darmwand liegende) Arterien wird die Verschlusseinrichtung in die Ligaturstellung gedreht. Die Ligatur wird in herkömmlicher Weise durch Detektion von entsprechenden Arterien mittels des Ultraschallsensors 27 (und einer entsprechenden Ansteuer- und Auswertelektronik) durch die Ligaturöffnung 26 durchgeführt, um die Blutzufuhr zum "Cavernosum recti" zu reduzieren.For subsequent ligature of intramural (= lying in the intestinal wall) arteries, the closure device is rotated into the ligature position. The ligature is performed in a conventional manner by detecting corresponding arteries by means of the ultrasonic sensor 27 (and a corresponding control and evaluation electronics) through the ligation opening 26 to reduce the blood supply to the "Cavernosum recti".

In der Folge wird durch Verdrehen der Verschlusseinrichtung die achsiale Öffnung 12 schrittweise von ihrem distalen Ende 14 her freigegeben, wobei vom Chirurgen eine fortlaufende Naht gelegt wird. Diese ergreift die Mukosa, die Submukosa und evtl. auch die "Muscularis mukosae". Mittels schlankem Nadelhalter und entsprechend gekrümmter Nadel wird durch den inneren Hohlraum 4 des Tubus 1 gearbeitet. Die fortlaufende Naht wird schrittweise über eine Länge von 4 bis 6 cm angelegt, bis in die Nähe der Linea dentata. Durch Knoten der fortlaufenden Naht in das distale Rektum erfolgt ein Repositionieren (bzw. ein Lifting bzw. eine Raffung) und ein Fixieren des Mukosaprolapses und eine anantomische Rekonstruktion des Corpus covernosum recti.As a result, by twisting the closure means, the axial opening 12 is gradually released from its distal end 14, with a continuous suture being applied by the surgeon. This takes the mucosa, the submucosa and possibly the "Muscularis mukosae". By means of a slender needle holder and a correspondingly curved needle is worked through the inner cavity 4 of the tube 1. The continuous suture is applied gradually over a length of 4 to 6 cm, to the vicinity of the dentate line. By knotting the continuous suture into the distal rectum, repositioning (or lifting) and fixation of the mucosal prolapse and an anomalous reconstruction of the corpus covernosum recti occurs.

Nach dem Verknoten der fortlaufenden Naht im Bereich des distalen Endes 14 der achsialen Öffnung 12 wird die Einrichtung aus dem Rektum entfernt, die Verschlusseinrichtung 15 in die Schließstellung gebracht und die Einrichtung neuerlich eingeführt, um den nächsten prolabierenden Schleimhautvorfall in derselben Weise zu behandeln. Dies wird wiederholt, bis über den Umfang des Rektums alle Schleimhautvorfälle behandelt worden sind.After knotting the continuous suture in the region of the distal end 14 of the axial opening 12, the device is removed from the rectum, the occluder 15 is brought to the closed position, and the device re-introduced to treat the next prolapsed mucosal prolapse in the same manner. This is repeated until all mucosal incidents have been treated over the circumference of the rectum.

Während der Operation ist es für den Chirurgen auch möglich, ein Instrument durch das offene distale Ende der Einrichtung durchzuführen und mit diesem Instrument prolabierte Schleimhaut in die distale Richtung zu drücken, um die Raffung zu unterstützen und die Naht zu entlasten.During surgery, it is also possible for the surgeon to force an instrument through the open distal end of the device and push the prolapsed mucosa in the distal direction with this instrument to assist gathering and relieve the suture.

Eine am distalen Ende geschlossene Ausbildung des Tubus 1 und/oder der Verschlusseinrichtung 15 ist denkbar und möglich, aber weniger bevorzugt.A closed at the distal end training of the tube 1 and / or the closure device 15 is conceivable and possible, but less preferred.

Zur definierten Einstellung der Drehstellungen der Verschlusseinrichtung 15 kann eine zwischen der Halterung 7 und der Verschlusseinrichtung 15 wirkende Rasteinrichtung vorhanden sein.For defined setting of the rotational positions of the closure device 15, a locking device acting between the holder 7 and the closure device 15 may be present.

Unterschiedliche weitere Modifikationen der beschriebenen Ausführungsbeispiele sind denkbar und möglich, ohne den Bereich der Erfindung, wie er in den Ansprüchen definiert ist, zu verlassen.Various other modifications of the described embodiments are conceivable and possible without departing from the scope of the invention as defined in the claims.

LegendeLegend zu den Hinweisziffern:to the reference numbers:

11
Tubustube
22
distales Ende des Tubusdistal end of the tube
33
proximales Ende des Tubusproximal end of the tube
44
innerer Hohlraum des Tubusinner cavity of the tube
55
Mantelwand des TubusMantle wall of the tube
66
Längsachselongitudinal axis
77
Halterungbracket
88th
Handgriffhandle
1212
Öffnung des TubusOpening of the tube
1313
proximales Ende der Öffnungproximal end of the opening
1515
Verschlusseinrichtungclosure device
1616
Verschlussteilclosing part
1717
Randedge
17a17a
Abschnitt des RandesSection of the edge
17b17b
Abschnitt des RandesSection of the edge
1818
Abschnitt der VerschlusseinrichtungSection of the closure device
2323
Randedge
2424
zylindrischer Abschnitt des Tubuscylindrical section of the tube
2525
Abschnitt des TubusSection of the tube
2626
Ligaturöffnungligature
2727
Ultraschallsensorultrasonic sensor
2828
elektrische Leitungelectrical line
2929
distaler Abschnittdistal section
3030
distales Ende der Verschlusseinrichtungdistal end of the closure device
3131
Anschlagelementstop element
3232
Anschlagattack
3333
Anschlagattack
3434
Öffnung im VerschlussteilOpening in the closure part
3535
Randedge
3636
Randedge

Claims (13)

  1. A device for use during the treatment of a haemorrhoid prolapse by application of a tightening seam comprising a tube (1), which has a distal end (2), by which it is capable of being inserted in advance into the rectum of a patient, and an open proximal end (3) and a casing wall (5), which surrounds an internal cavity (4) and which is provided with an elongate opening (12) which extends in the axial direction of the tube (1), and a closure device (15) which closes the opening (12) in a closure position and by which the opening (12) is capable of being exposed in succession from distal to proximal and which has a closure part (16), inside which the tube (1) is arranged and which is formed by part of a casing of a hollow cylinder and is rotatable about the longitudinal axis (6) of the tube (1) with respect to the tube (1), characterized in that an ultrasonic sensor (27) is arranged on the tube (1), and the tube (1) has a ligature opening (26), wherein the ultrasonic sensor (27) is arranged proximally adjacent to the ligature opening (26).
  2. A device according to Claim 1, characterized in that the elongate opening (12) of the tube (1) is capable of being exposed in a continuous manner by the closure device (15).
  3. A device according to Claim 1 or Claim 2, characterized in that the casing wall (5) of the tube (1) is made cylindrical, at least over a portion (24) of the tube (1).
  4. A device according to Claim 3, characterized in that the cylindrical portion (24) of the tube (1) makes up the greater part of the longitudinal extension of the tube (1).
  5. A device according to any one [of] Claims 1 to 4, characterized in that the internal diameter of the closure part (16) plus a degree of clearance in order to form a sliding guide on the tube (1) corresponds to the external diameter of the portion of the tube (1) surrounded by the closure part (16).
  6. A device according to any one of Claims 1 to 5, characterized in that the peripheral extension of the closure part (16) in the axial region of the opening (12) of the tube (1) corresponds at least to the width (b) of the opening (12), and the opening (12) of the tube (1) is completely covered with respect to the tube (1) by the closure part (16) in a rotational position of the closure part (16), and is capable of being exposed in a continuous manner from distal to proximal by a rotation of the closure part (16) with respect to the tube (1).
  7. A device according to any one of Claims 1 to 6, characterized in that the closure part (16) has an edge (17; 17a) extending in a helical manner about the longitudinal axis (6) of the tube (1).
  8. A device according to Claim 7, characterized in that the closure part (16) has an edge (23) extending in the axial direction.
  9. A device according to any one of Claims 1 to 8, characterized in that the tube (1) is attached to a holding means (7) which has a handle (8).
  10. A device according to any one of Claims 1 to 9, characterized in that an illumination device is provided in order to illuminate the operation area.
  11. A device according to any one of Claims 1 to 10, characterized in that a stop is provided in order to limit the insertion of the tube (1) into the rectum.
  12. A device according to any one of Claims 1 to 11, characterized in that the ligature opening (26) is capable of being closed and exposed by the closure device (15).
  13. A device according to any one of Claims 1 to 12, characterized in that the ligature opening (26) is constructed in the form of a lateral extension of the axial opening (12) in the tube (1) in the region of the distal end (14) of the axial opening (12).
EP06000772A 2005-01-25 2006-01-14 Device for use in treatment of hemorrhoidal prolapse Active EP1683473B1 (en)

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
AT1082005 2005-01-25
AT0143805A AT501766A1 (en) 2005-01-25 2005-09-02 DEVICE FOR USE IN THE TREATMENT OF A HEMORRHOIDENEPROLAP

Publications (2)

Publication Number Publication Date
EP1683473A1 EP1683473A1 (en) 2006-07-26
EP1683473B1 true EP1683473B1 (en) 2007-11-28

Family

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Family Applications (1)

Application Number Title Priority Date Filing Date
EP06000772A Active EP1683473B1 (en) 2005-01-25 2006-01-14 Device for use in treatment of hemorrhoidal prolapse

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US (1) US7695432B2 (en)
EP (1) EP1683473B1 (en)
AT (1) AT501766A1 (en)
DE (1) DE502006000196D1 (en)
ES (1) ES2297770T3 (en)

Families Citing this family (40)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US8029520B2 (en) * 2006-02-07 2011-10-04 Ethicon Endo-Surgery, Inc. Method for performing trans-anal resection with a curved cutter stapler
EP2163188B1 (en) * 2006-02-14 2011-05-04 THD S.p.A. A device for surgical treatment of rectal and haemorrhoidal prolapse
AT505002B1 (en) * 2007-04-23 2008-10-15 Ami Gmbh DEVICE FOR USE IN THE TREATMENT OF A HEMORRHOIDENEPROLAP
ITTO20080032U1 (en) * 2007-05-11 2008-09-12 Ceramoptec Gmbh SYSTEM AND METHOD FOR HEMORROID TREATMENT
CN103767753B (en) * 2007-12-27 2016-08-24 苏州天臣国际医疗科技有限公司 A kind of for the operating assistive device of non-annular cutting hemorrhoid
BRPI0823114B1 (en) * 2008-10-06 2017-04-11 Thd Spa prolapse surgery device
CN103654914B (en) * 2008-11-04 2016-05-25 苏州天臣国际医疗科技有限公司 A kind of assistive device for anal-surgery
CN103654915B (en) * 2008-11-04 2016-04-13 苏州天臣国际医疗科技有限公司 A kind of assistive device for anal-surgery
US9232947B2 (en) 2009-02-17 2016-01-12 The Board Of Trustees Of The Leland Stanford Junior University Closure device and method
EP2269516B1 (en) * 2009-06-29 2013-01-02 National Cancer Center Surgical apparatus for transanal endoscopic microsurgery
US9724079B2 (en) * 2009-11-09 2017-08-08 Entourage Medical Technologies, Inc. System and method for providing access and closure to tissue
US10709896B2 (en) * 2009-12-22 2020-07-14 Biolitec Unternehmensbeteiligungs Ii Ag System and method for treating hemorrhoids
CN102217964B (en) * 2010-04-15 2016-04-27 韩美药品株式会社 For the hemorrhoid artery ligation device of hemorrhoid treating
US8632458B2 (en) 2011-10-26 2014-01-21 Macroplata Inc. Gentle hemorrhoid treatment offering a substantially painless healing
JP5871915B2 (en) 2010-06-11 2016-03-01 アントラージュ メディカル テクノロジーズ，インコーポレイテッドＥｎｔｏｕｒａｇｅ Ｍｅｄｉｃａｌ Ｔｅｃｈｎｏｌｏｇｉｅｓ，Ｉｎｃ． System and method for transapical access and closure
US9161778B2 (en) 2010-06-11 2015-10-20 Entourage Medical Technologies, Inc. System and method for transapical access and closure
US20120071922A1 (en) 2010-09-20 2012-03-22 Shanley John F System for providing surgical access
US9149271B2 (en) 2010-11-22 2015-10-06 The Board Of Trustees Of The Leland Stanford, Jr. University Device and method for treatment of hemorrhoids
CN101991904B (en) * 2010-12-10 2013-06-05 苏州天臣国际医疗科技有限公司 Anus expanding device
US20120182631A1 (en) * 2011-01-13 2012-07-19 Poincare Systems, Inc. Motor components and devices incorporating such motor components
EP2704672B1 (en) 2011-05-05 2016-02-10 Relief Therapies, Inc. Device for protecting hemorrhoids
US20140128677A1 (en) * 2012-07-30 2014-05-08 Janet Lenart Enema and Coloscopy Aide
US8789243B2 (en) * 2012-09-19 2014-07-29 Ecolab Usa Inc. Disposable handle cover for a surgical lighthead
JP2016537162A (en) 2013-10-29 2016-12-01 アントラージュ メディカル テクノロジーズ，インコーポレイテッドＥｎｔｏｕｒａｇｅ Ｍｅｄｉｃａｌ Ｔｅｃｈｎｏｌｏｇｉｅｓ，Ｉｎｃ． System for providing surgical access
CN103815941B (en) * 2014-02-28 2016-06-22 南京奥珂森电子有限公司 Split type Proctoscopic ultrasonic Doppler probe
US9850602B2 (en) * 2014-03-14 2017-12-26 Thomas Wrobel Braiding disk handle
US11883236B2 (en) * 2014-04-29 2024-01-30 The Board Of Regents Of The University Of Texas System Methods and systems for detecting sub-tissue anomalies
CN104116548B (en) * 2014-07-16 2018-06-01 北京派尔特医疗科技股份有限公司 A kind of auxiliary dress of anal-surgery is put
CN105311732B (en) * 2014-07-25 2018-09-25 北京派尔特医疗科技股份有限公司 A kind of auxiliary dress of anal-surgery is set
CN104287785B (en) * 2014-10-28 2016-08-17 北京派尔特医疗科技股份有限公司 A kind of anal-surgery auxiliary device
US20170000322A1 (en) * 2015-07-01 2017-01-05 Christopher Fleming Intra-illuminating device
IT201600112850A1 (en) * 2016-11-09 2018-05-09 Francesco Sias anoscope
US11497507B2 (en) 2017-02-19 2022-11-15 Orpheus Ventures, Llc Systems and methods for closing portions of body tissue
CN107007304A (en) * 2017-05-25 2017-08-04 苏州乐步生物科技有限公司 A kind of proctoscope doppler transducer
SE541467C2 (en) * 2017-10-13 2019-10-08 Dev Ab Device for use in the treatment of hemorrhoids
CN108175372B (en) * 2018-01-10 2023-05-30 苏州贝诺医疗器械有限公司 Rectal prolapse measuring instrument
GB2580407B (en) * 2019-01-10 2022-05-25 Haemoband Surgical Ltd A rectal insertion device
CN109893314B (en) * 2019-03-13 2021-07-30 深圳市美好创亿医疗科技股份有限公司 Silicone stent conveying device
WO2021011170A1 (en) * 2019-07-16 2021-01-21 Boston Scientific Scimed, Inc. Device and methods for inspection and treatment of hemorrhoids
US11937827B2 (en) 2019-07-24 2024-03-26 Boston Scientific Scimed, Inc. Device and method for treatment of hemorrhoids

Family Cites Families (13)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
DE8316987U1 (en) * 1983-11-10 Berger, Zoltan, 7770 Überlingen Proctoscope
US295798A (en) * 1884-03-25 Speculum
US5025778A (en) * 1990-03-26 1991-06-25 Opielab, Inc. Endoscope with potential channels and method of using the same
US5570692A (en) * 1995-05-19 1996-11-05 Hayashi Denki Co. Ltd. Ultrasonic doppler blood flow detector for hemorrhoid artery ligation
JP3429685B2 (en) * 1997-10-06 2003-07-22 オリンパス光学工業株式会社 Endoscope guide tube
US6126594A (en) * 1998-07-21 2000-10-03 Bayer; Izhack Anoscope for internal hemorrhoidectomy
US6142933A (en) * 1998-11-23 2000-11-07 Ethicon Endo-Surgery, Inc. Anoscope for hemorrhoidal surgery
EP1234539A3 (en) * 2001-02-15 2002-09-11 AMI (Agency for medical innovations GmbH) Device for use during the ligature of an intramural artery in a body cavity
US6632227B2 (en) * 2001-08-24 2003-10-14 Scimed Life Systems, Inc. Endoscopic resection devices
CA2363473C (en) * 2001-11-20 2010-10-19 Marc G. Morin Anoscope
DE10231004A1 (en) * 2002-07-09 2004-01-22 Dwl Elektronische Systeme Gmbh proctoscope
ITMO20020246A1 (en) * 2002-09-09 2004-03-10 Francesco Sias ROTATING OPERATING ANOSCOPE.
JP4642477B2 (en) * 2003-01-21 2011-03-02 ティーエイチディー エス．ピー．エー． Surgical retractor for hemorrhoid artery

Also Published As

Publication number Publication date
DE502006000196D1 (en) 2008-01-10
AT501766A1 (en) 2006-11-15
ES2297770T3 (en) 2008-05-01
US7695432B2 (en) 2010-04-13
US20060167473A1 (en) 2006-07-27
EP1683473A1 (en) 2006-07-26

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